SEC Form 3
FORM 3 | UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940 |
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1. Name and Address of Reporting Person*
(Street)
| 2. Date of Event Requiring Statement (Month/Day/Year) 06/01/2016 | 3. Issuer Name and Ticker or Trading Symbol Anthem, Inc. [ ANTM ] | |||||||||||||
4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
| 5. If Amendment, Date of Original Filed (Month/Day/Year) | ||||||||||||||
6. Individual or Joint/Group Filing (Check Applicable Line)
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Table I - Non-Derivative Securities Beneficially Owned | |||
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1. Title of Security (Instr. 4) | 2. Amount of Securities Beneficially Owned (Instr. 4) | 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 4. Nature of Indirect Beneficial Ownership (Instr. 5) |
Common Stock | 17,241(1) | D |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||
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1. Title of Derivative Security (Instr. 4) | 2. Date Exercisable and Expiration Date (Month/Day/Year) | 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) | 4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 6. Nature of Indirect Beneficial Ownership (Instr. 5) | ||
Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||
Employee Stock Option (Right to Buy) | (2) | 03/01/2020 | Common Stock | 3,948 | 61.88 | D | |
Employee Stock Option (Right to Buy) | (3) | 03/03/2021 | Common Stock | 6,466 | 89.44 | D | |
Employee Stock Option (Right to Buy) | (4) | 03/01/2026 | Common Stock | 5,883 | 131.8 | D | |
Employee Stock Option (Right to Buy) | (5) | 03/02/2025 | Common Stock | 5,775 | 146.93 | D |
Explanation of Responses: |
1. Includes 5,377 restricted shares which vest on various dates between March 2, 2017 and March 1, 2019. |
2. The option, representing a right to purchase a total of 11,843 shares, became exercisable in one installment of 1,973 shares and five semi-annual installments of 1,974 shares each beginning on September 1, 2013, which was the six-month anniversary of the date on which the option was granted. |
3. The option, representing a right to purchase a total of 9,698 shares, became exercisable in four semi-annual installments of 1,616 shares each and two semi-annual installments of 1,617 shares each beginning on September 3, 2014, which was the six-month anniversary of the date on which the option was granted. |
4. The option representing a right to purchase a total of 5,883 shares, is exercisable in three semi-annual installments of 980 shares each and three semi-annual installments of 981 shares each, beginning on September 1, 2016, which is the six-month anniversary of the option grant date. |
5. The option representing a right to purchase a total of 5,775 shares, became exercisable in three semi-annual installments of 962 shares each and three semi-annual installments of 963 shares each, beginning on September 2, 2015, which was the six-month anniversary of the option grant date. |
Remarks: |
Exhibit List: Exhibit 24-Power of Attorney |
/s/ Kathleen S. Kiefer, Attorney in fact | 06/03/2016 | |
** Signature of Reporting Person | Date | |
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | ||
* If the form is filed by more than one reporting person, see Instruction 5 (b)(v). | ||
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). | ||
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure. | ||
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number. |